Enabling The Use Of Multiple Picture Archiving Communication Systems By One Or More Facilities On A Shared Domain

ABSTRACT

Methods, systems, and computer-storage media are provided for utilizing multiple Picture Archiving Communication Systems (PACS) to view one more medical images by storing one or more PACS at a database within the system. Requests are received from one or more users at one or more facilities to utilize one or more PACS to view one or more medical images. After accessing the database to determine one or more PACS authorized for each facility from which a request is received, one or more users are provided with one or more PACS to view medical images associated with radiological exams and provide the necessary assessments and reports for treatment.

BACKGROUND

Over the years, the cost of healthcare has increased significantly andthe management of individual healthcare has become more complex. In thecourse of treating individuals for various healthcare problems,healthcare providers frequently order radiological examinations fordiagnostic and treatment purposes. Once a radiological exam, such as anx-ray, is conducted, a radiologist receives a request to review theimage generated by the radiological exam. The radiologist, who may ormay not be located at the facility where the radiological exam is takingplace, then utilizes a Picture Archiving Communication Systems (PACS) toview the medical image and generate a report indicating the radiologicalfindings. There are multiple different types of PACS available forviewing different types of radiological examinations.

To decrease costs, various elements of healthcare management areoutsourced to healthcare providers, such as radiologists, who may not bephysically onsite at a facility. Additionally, more than one facilitymay share a domain to further reduce costs. Currently, healthcaremanagement systems are configured to allow the use of only one type ofPACS for each domain, which limits the ability of radiologists to viewdifferent medical images via different PACS. As such, a system thatwould allow for the use of different PACS within a domain, would providegreater flexibility to radiologists viewing and analyzing radiologicalexams. Further, such a system would also be cost effective as it wouldallow different facilities within one domain to utilize different PACSand make it easier for radiologists viewing images remotely to utilize avariety of different PACS for different facilities to review medicalimages and provide assessments.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used as an aid in determining the scope of the claimed subjectmatter. The present invention is defined by the claims.

Various types of radiological exams are a critical and regular componentof managing the healthcare of an individual. Radiological exams are usedto diagnose the cause of symptoms presented, monitor how an individual'sbody is responding to treatment, and screen for different illnesses suchas cancer or heart disease. As technology has progressed over the years,there are numerous types of radiological exams available for a varietyof needs. Some examples of common radiological examinations utilizedregularly are x-rays, magnetic resonance imaging (MRIs), computedtomography scan (CT or CAT scan), fluoroscopy, mammography, nuclearmedicine (e.g. bone scans), positron emission tomography (PET scan), andultrasounds. Each type of radiological exam may require a different typeof PACS to view the image. PACS is medical imaging technology thatprovides economical storage and convenient access to images frommultiple modalities. Electronic images and reports are transmitteddigitally via PACS, which eliminates the need to manually file, retrieveor transport radiological images. Combined with available and emergingtechnology, PACS has the ability to deliver timely and efficient accessto images, interpretations, and related data. PACS also reduces thephysical and time barriers associated with traditional film-based imageretrieval, distribution, and display.

In some instances, a PACS may be configured to produce images forvarious radiological exams. In other instances, each PACS could becustomized to be used for a specific type of radiological image. Assuch, when a radiologist views the medical images generated from theradiological exam, the radiologist may need to utilize more than onetype of PACS to review the image and make their medical assessments.Further, each radiologist may also have a preferred PACS for viewing andanalyzing images based on the PACS technology or personal preference.

Currently, configurations of all PACS are stored in a system registrywhich imposes the restriction that only one PACS can be utilized perdomain. Multiple facilities often share domains in order to reduce thecost of operating a domain. For example, small community hospitalswithin one region may share a common domain to decrease costs. As such,if three community hospitals are sharing the same domain, each hospitalmust use the same PACS to view radiological medical images. Thislimitation presents challenges for radiologist who may have preferredPACS for viewing medical images and making assessments or if certainPACS have limitations in their capabilities. Further, facilities mayprefer to use different PACS based on the cost associated with eachPACS. As such, the current configuration limiting the facilities sharinga domain to one PACS may increase costs for certain facilities.Additionally, the limitation of utilizing only one PACS per domain mayalso hinder the quality of the medical images viewed and the potentialmedical assessments made. Some PACS programs may have better technologyor may be more optimal for use for certain x-rays. For example, a PACSutilized to view mammograms, x-rays, and ultrasounds may not be the bestPACS for viewing more complex imaging such as PET or MRI scans.

PACS utilized by radiologists may be utilized via a radiologist desktop(RDT) application or the electronic medical record (EMR) application.For example, from the EMR, a radiologist may launch an PACS associatedwith the EMR for viewing the image. However, in the currentconfiguration, if the EMR's PACS is utilized, no other 3^(rd) party PACScan be utilized. Once again, this presents limitations on radiologistsand facilities who may need or want to utilize different PACS for thereview of different types of medical images. In aspects where the PACSis launched on an RDT application, the RDT application may communicatewith the EMR to deliver reports or other medical data associated withthe assessment of the medical image reviewed.

At a high level, the present disclosure discloses the configuration ofthe PACS at the database level rather than the registry level within adomain. By changing where each of the PACS are stored from the registrylevel to the database level, multiple PACS can be utilized by differentfacilities within one shared domain. Each PACS is stored as a key valuepair associated with each authorized facility in the database. Each PACSthat is configured is associated with specific facilities, which allowsradiologists at each facility to access the PACS that are approved forthe individual facility. This also allows the radiologists to togglebetween different PACS as needed. As a result, this new configurationeliminates the previous restrictions where only one PACS could beutilized by all facilities within a domain and allows for the use ofboth a 3^(rd) party PACS and EMR specific PACS.

Aspects herein describe computer-storage media, computerized methods,and computing systems that allow healthcare providers, such asradiologists, to utilize multiple PACS to view different medical images.The system comprises receiving an indication to launch a radiologydesktop (RDT) application on a first user interface at a first facility.Then the system receives a request from the user to utilize one or morePACS to view one or more medical images. In response, a database isaccessed to identify one or more PACS authorized for use at the firstfacility. The first user is then provided, via the first user interfaceof the RDT, with a first PACS authorized for use by the first user atthe first facility. The first user is also provided with a second PACS,via the first user's interface of the RDT application, for use by thefirst user at the first facility.

As well, aspects herein are also directed to a system that comprises adatabase comprising one or more PACS configured to capture, store, anddisplay one or more medical images on one or more user interfacesassociated with one or more facilities. The system also comprises one ormore processors and a storage device storing a computer program productcomprising computer instructions that, upon execution by the one or moreprocessors, cause the one or more processors to perform operationscomprising receiving a first indication to launch a RDT application on afirst user interface at a first facility and a second indication tolaunch a RDT application on a second user interface at a secondfacility. Then, the system receives a first request from the first userto utilize one or more PACS to view one or more medical images and asecond request from the second user to utilize one or more PACS to viewone or more medical images. The system accesses the database to identifyone or more PACS authorized for the first user at the first facility andthe second user at the second facility. Once the authorized PACS areidentified, the system provides the first user with one or more PACSauthorized for use by the first user at the first facility and thesecond user with one or more PACS authorized for use by the second userat the second facility. Then, a selection from the first user of a firstPAC for viewing one or more medical images and a selection from thesecond user of a second PACS for viewing one or more medical images isreceived. Based on the these selections, a first medical image, via thefirst PACS, is generated for review by the first user and a secondmedical image is generated, via the second PACS, for review by thesecond user.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments are described in detail below with reference to the attacheddrawings figures, wherein:

FIG. 1 is a block diagram of an exemplary computing environment suitableto implement embodiments of the present invention;

FIG. 2 is an exemplary system architecture suitable to implementembodiments of the present invention;

FIG. 3 illustrates an exemplary system workflow illustratingimplementation of embodiments of the present application;

FIG. 4 illustrates an exemplary virtual desktop infrastructure where asingle PACS is configured at the registry level of a domain;

FIG. 5 illustrates an exemplary virtual desktop infrastructure where thePACS are configured at the database level allowing for use of multiplePACS within one domain;

FIG. 6 illustrates an exemplary radiologist desktop applicationconfigured for multiple PACS use;

FIG. 7 illustrates the use of multiple PACS by different users atdifferent facilities sharing the same domain;

FIG. 8 is a flow diagram descripting an exemplary method of executingembodiments of the present invention; and

FIG. 9 is a flow diagram descripting another exemplary method ofexecuting embodiments of the present invention.

DETAILED DESCRIPTION

The subject matter of the present invention is described withspecificity herein to meet statutory requirements. However, thedescription itself is not intended to limit the scope of this patent.Rather, the inventors have contemplated that the claimed subject mattermight also be embodied in other ways, to include different steps orcombinations of steps similar to the ones described in this document, inconjunction with other present or future technologies. Moreover,although the terms “step” and/or “block” may be used herein to connotedifferent elements of methods employed, the terms should not beinterpreted as implying any particular order among or between varioussteps herein disclosed unless and except when the order of individualsteps is explicitly described.

Embodiments of the present invention are directed to methods, systems,and computer-storage media for computer-based medical information usersto monitor an individual's risk for a second event to occur subsequentto a first event based on an analysis of pre-selected medical dataelements. Following a first event, a server automatically accesses anelectronic medical record store on a predetermined schedule to sample apre-selected set of medical data elements. A logistic regressionanalysis is completed on the preselected set of medical data elements togenerate a second risk score indicating the degree of risk that thesecond event will occur.

As used herein, the term facility, may be any facility which provideshealthcare to an individual such as, but not limited to, a hospital,acute care facility, rehabilitation facility, urgent care facilities andthe like.

An exemplary computing environment suitable for use in implementingembodiments of the present invention is described below. FIG. 1 is anexemplary computing environment (e.g., medical-informationcomputing-system environment) with which embodiments of the presentinvention may be implemented. The computing environment is illustratedand designated generally as reference numeral 100. The computingenvironment 100 is merely an example of one suitable computingenvironment and is not intended to suggest any limitation as to thescope of use or functionality of the invention. Neither should thecomputing environment 100 be interpreted as having any dependency orrequirement relating to any single component or combination ofcomponents illustrated therein. It will be appreciated by those havingordinary skill in the art that the connections illustrated in FIG. 1 arealso exemplary as other methods, hardware, software, and devices forestablishing a communications link between the components, devices,systems, and entities, as shown in FIG. 1, may be utilized in theimplementation of the present invention. Although the connections aredepicted using one or more solid lines, it will be understood by thosehaving ordinary skill in the art that the exemplary connections of FIG.1 may be hardwired or wireless, and may use intermediary components thathave been omitted or not included in FIG. 1 for simplicity's sake. Assuch, the absence of components from FIG. 1 should not be interpreted aslimiting the present invention to exclude additional components andcombination(s) of components. Moreover, though devices and componentsare represented in FIG. 1 as singular devices and components, it will beappreciated that some embodiments may include a plurality of the devicesand components such that FIG. 1 should not be considered as limiting thenumber of a device or component.

The present technology might be operational with numerous otherspecial-purpose computing system environments or configurations.Examples of well-known computing systems, environments, and/orconfigurations that might be suitable for use with the present inventioninclude personal computers, server computers, hand-held or laptopdevices, multiprocessor systems, microprocessor-based systems, set topboxes, programmable consumer electronics, network PCs, minicomputers,mainframe computers, distributed computing environments that include anyof the above-mentioned systems or devices, and the like.

The present invention may be operational and/or implemented acrosscomputing system environments such as a distributed or wireless “cloud”system. Cloud-based computing systems include a model of networkedenterprise storage where data is stored in virtualized storage pools.The cloud-based networked enterprise storage may be public, private, orhosted by a third party, in embodiments. In some embodiments, computerprograms or software (e.g., applications) are stored in the cloud andexecuted in the cloud. Generally, computing devices may access the cloudover a wireless network and any information stored in the cloud orcomputer programs run from the cloud. Accordingly, a cloud-basedcomputing system may be distributed across multiple physical locations.

The present technology might be described in the context ofcomputer-executable instructions, such as program modules, beingexecuted by a computer. Exemplary program modules comprise routines,programs, objects, components, and data structures that performparticular tasks or implement particular abstract data types. Thepresent invention might be practiced in distributed computingenvironments where tasks are performed by remote processing devices thatare linked through a communications network. In a distributed computingenvironment, program modules might be located in association with localand/or remote computer storage media (e.g., memory storage devices).

With continued reference to FIG. 1, the computing environment 100comprises a computing device in the form of a control server 102.Exemplary components of the control server 102 comprise a processingunit, internal system memory, and a suitable system bus for couplingvarious system components, including data store 104, with the controlserver 102. The system bus might be any of several types of busstructures, including a memory bus or memory controller, a peripheralbus, and a local bus, using any of a variety of bus architectures.Exemplary architectures comprise Industry Standard Architecture (ISA)bus, Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus,Video Electronic Standards Association (VESA) local bus, and PeripheralComponent Interconnect (PCI) bus, also known as Mezzanine bus.

The control server 102 typically includes therein, or has access to, avariety of non-transitory computer-readable media. Computer-readablemedia can be any available media that might be accessed by controlserver 102, and includes volatile and nonvolatile media, as well as,removable and nonremovable media. By way of example, and not limitation,computer-readable media may comprise computer storage media andcommunication media. Computer storage media includes volatile andnonvolatile, removable and non-removable media implemented in any methodor technology for storage of information such as computer-readableinstructions, data structures, program modules or other data. Computerstorage media includes, but is not limited to, RAM, ROM, EEPROM, flashmemory or other memory technology, CD-ROM, digital versatile disks (DVD)or other optical disk storage, magnetic cassettes, magnetic tape,magnetic disk storage or other magnetic storage devices, or any othermedium which can be used to store the desired information and which canbe accessed by control server 102. Computer-readable media does notinclude signals per se.

Communication media typically embodies computer-readable instructions,data structures, program modules or other data in a modulated datasignal such as a carrier wave or other transport mechanism and includesany information delivery media. The term “modulated data signal” means asignal that has one or more of its characteristics set or changed insuch a manner as to encode information in the signal. By way of example,and not limitation, communication media includes wired media such as awired network or direct-wired connection, and wireless media such asacoustic, RF, infrared and other wireless media. Combinations of any ofthe above should also be included within the scope of computer-readablemedia.

The control server 102 might operate in a computer network 106 usinglogical connections to one or more remote computers 108. Remotecomputers 108 might be located at a variety of locations includingoperating systems, device drivers and medical information workflows. Theremote computers might also be physically located in traditional andnontraditional medical/healthcare care environments so that the entiremedical community might be capable of integration on the network. Theremote computers might be personal computers, servers, routers, networkPCs, peer devices, other common network nodes, or the like and mightcomprise some or all of the elements described above in relation to thecontrol server. The devices can be personal digital assistants or otherlike devices. Further, remote computers may be located in a variety oflocations including in a medical or research environment, includingclinical laboratories (e.g., molecular diagnostic laboratories),hospitals and other inpatient settings, veterinary environments,ambulatory settings, medical billing and financial offices, hospitaladministration settings, home healthcare environments, and clinicians'offices. Health care providers may comprise a treating physician orphysicians; specialists such as surgeons, radiologists, cardiologists,and oncologists; emergency medical technicians; physicians' assistants;nurse practitioners; nurses; nurses' aides; pharmacists; dieticians;microbiologists; laboratory experts; laboratory technologists; geneticcounselors; researchers; veterinarians; students; and the like. Theremote computers 108 might also be physically located in nontraditionalmedical care environments so that the entire medical community might becapable of integration on the network. The remote computers 108 might bepersonal computers, servers, routers, network PCs, peer devices, othercommon network nodes, or the like and might comprise some or all of theelements described above in relation to the control server 102. Thedevices can be personal digital assistants or other like devices.

Computer networks 106 comprise local area networks (LANs) and/or widearea networks (WANs). Such networking environments are commonplace inoffices, enterprise-wide computer networks, intranets, and the Internet.When utilized in a WAN networking environment, the control server 102might comprise a modem or other means for establishing communicationsover the WAN, such as the Internet. In a networking environment, programmodules or portions thereof might be stored in association with thecontrol server 102, the data store 104, or any of the remote computers108. For example, various application programs may reside on the memoryassociated with any one or more of the remote computers 108. It will beappreciated by those of ordinary skill in the art that the networkconnections shown are exemplary and other means of establishing acommunications link between the computers (e.g., control server 102 andremote computers 108) might be utilized.

In operation, an organization might enter commands and information intothe control server 102 or convey the commands and information to thecontrol server 102 via one or more of the remote computers 108 throughinput devices, such as a keyboard, a microphone (e.g., voice inputs), atouch screen, a pointing device (commonly referred to as a mouse), atrackball, or a touch pad. Other input devices comprise satellitedishes, scanners, or the like. Commands and information might also besent directly from a remote medical device to the control server 102. Inaddition to a monitor, the control server 102 and/or remote computers108 might comprise other peripheral output devices, such as speakers anda printer.

Although many other internal components of the control server 102 andthe remote computers 108 are not shown, such components and theirinterconnection are well known. Accordingly, additional detailsconcerning the internal construction of the control server 102 and theremote computers 108 are not further disclosed herein.

Turning now to FIG. 2, an exemplary computing system 200 is depicted.The computing system 200 (hereinafter “system”) is merely an example ofone suitable computing system and is not intended to suggest anylimitation as to the scope of use or functionality of embodiments of thepresent invention. Neither should the system 200 be interpreted ashaving any dependency or requirement related to any single component orcombination of components illustrated herein.

In some embodiments, one or more of the illustrated components may beimplemented as a stand-alone application. The components described areexemplary in nature and in number and should not be construed aslimiting. Any number of components may be employed to achieve thedesired functionality within the scope of the embodiments hereof.Further, components may be located on any number of servers.

In the embodiment shown in FIG. 2, the system 200 includes a PACSmanager 202, database 204, network 206, computer server 208, radiologydesktop (RDT) application 210, and electronic medical record 226. WhileFIG. 2 illustrates only one computer server 208, it is contemplated thatthe system 200 may comprise any number of servers 208.

The electronic medical record 226 is comprised of in exemplary aspects,medication information, vital sign information, physician orders,demographic information, laboratory and/or procedure values and results,medical history (symptoms, diagnoses, and the like), medication history,medical procedure history, treatment history, number of readmissions andcauses for readmission, social determinants (health literacy, behavioralfactors, support network, and the like), assessment information for theindividual, and any other pertinent medical data monitored by ahealthcare system. The EMR further comprises an EMR PACS 236, which isbuilt into the EMR. The EMR PACS 236 is available within the EMR 226 toview medical images within the EMR and report findings. Previously,users were limited to either using the EMR PACS 236 or a third partyPACS, such as PACS A (228), but could not utilize both at the same time.

The RDT application 210 comprises an image viewer 224. The RDTapplication is utilized by a radiologist to view medical images fromvarious radiological exams. The image viewer 224 is located within theRDT application and launches the actual medical image. As will discussedherein, a radiologist will launch the RDT application, which may beconfigured to communicate with a PACS so that the PACS is utilized totransmit the medical images from radiological exams to the image viewer224 on the RDT application. The RDT application 210 may be located onany user device, such as a laptop.

As will be escribed herein, there are multiple PACS that are storedwithin the database 204, which allows for the use of multiple PACS bymore than one facility sharing the same domain. As shown, the exemplarydatabase comprises PACS A 228, PACS B 230, PACS C 232, and PACS D. EachPACS is stored as a key value pair and associated with one or moreauthorized facilities within the database 204. For example, PACS A 228may be stored with key value pairs that indicate that PACS A isauthorized for use at all facilities utilizing the domain. By contrast,PACS B 230 may only be authorized for use at a single facility. Whiledatabase 204 comprises four exemplary PACS in FIG. 2, it is contemplatedthat the database my store as many different PACS as needed while notexceeding the database 204's storage capacity.

Generally, the PACS manager 202 is configured to allow a healthcareprovider to utilized multiple PACS to view one or more medical images.In this embodiment, the PACS manager 202 is comprised of an indicationreceiver 212, a request receiver 214, an accessor 216, a provider 218, aselection receiver 220, and a generator 222. In this aspect, the PACSmanager 202 is comprised of six subcomponents (listed above). However,in other aspects, the PACS manager 202 may be comprised of more or lesscomponents and any and all variations are contemplated herein. Thecomponents described are exemplary in nature and in number and shouldnot be construed as limited. Any number of components may employed toachieve the desired functionality within the scope of the embodimentshereof.

Additionally, in some aspects, the PACS manager may also be locatedwithin the database 204. It will be appreciated that some or all of thesubcomponents of the PACS manager 202 may be accessed via the network206 and may reside on one or more devices. Further, while system 200 iscomprised of one PACS manager 202, it is contemplated that the system200 may include more than one PACS manager 202. It is also contemplatedthat the PACS manager may be integrated into the RDT application 210.

The indication receiver 212 within the PACS manager 202 is configured toreceive an indication to launch a radiology desktop application 210 on auser interface at a first facility. The indication receiver may receivethe indication to launch the RDT application 210 from a healthcareprovider, such as a radiologist, who needs to review one or more medicalimages for one or more individuals and prepare assessments and diagnosesregarding the one or more medical images. The indication received by theindication receiver 212 to launch the RDT application may be receivedfrom a user at a facility, such as a hospital. In some instances, theindication to launch the RDT may be received from a user workingremotely from another location outside the facility.

The request receiver 214 receives a request from the user to utilize oneor more PACS to view one or more medical images. The request receiver214 may receive the request to utilize one or more PACS from the system200 or a user. When a user, such as a radiologist, either at a facilityor remotely needs to review medical images from radiological exams, theradiologist may launch the RDT application 210 and send a request to thesystem to utilize one or more PACS. In order to view the specificmedical image desired, the radiologist will need to utilize a PACS totransmit the medical images to be reviewed. When the request receiver214 receives the request from a radiologist, the request may indicatewhich PACS is desired to be used. Additionally, the request received bythe request receiver 214 may also compromise an order number that isassociated with the radiological exam and medical image to be viewed.Previously, the radiologist would have only had one PACS available foruse at a facility. However, the present system allows the radiologist tobe able to choose more than one PACS that are approved for use for thefacility associated with the radiologist.

Next, the accessor 216 accesses the database 204 to identify one or morePACS authorized for use at a first facility. As mentioned, the system200 allows for the use of multiple PACS on one domain for one or morefacilities, which is an improvement to existing technology and removesthe previous restrictions of prior systems. While more than one PACS maybe utilized, not all PACS may be available for each facility on a shareddomain. For example, facility A may be authorized to use PACS A 228,PACS B 230, and PACS C 232. Facility B, located on the same domain, maybe authorized to use PACS B 230 and PACS C 232 only. As such, when therequest receiver 214 receives the request to utilize one or more PACS toview one or more medical images, the accessor 216 that accesses thedatabase 204 will identify only those PACS that are authorized for useat the facility associated with the request. In some aspects, a domainmay be shared by multiple facilities within a large healthcare system(e.g. urban hospital system with multiple locations). In this case, eachseparate facility within the same healthcare system may have differentauthorized PACS. In other aspects, the domain may be shared by multipledifferent facilities that have no relationship with one another.Therefore, based on the location from where the request receiver 214receives the request to utilize one or more PACS from a first user, theaccessor 216 will access the database 204 and identify the one or moreauthorized PACS available for the particular facility location.

Once the accessor 216 has identified the one or more PACS authorized foruse at a first facility, the provider 218 will provide the first user,via the first user interface of the RDT application, with a first PACSauthorized at the first facility. To do this, the provider 218 willprovide a first PACS for selection on the first user interface. Forexample, if the radiologist has requested to use PACS A at the firstfacility and the accessor 216 has identified that PACS A is authorizedfor the first facility, then the provider 218 will provide PACS A foruse by the radiologist at the first facility on a user interface. Insome aspects, the first user may be presented with the option to usePACS A via the RDT application. In other aspects, the first user may beutilizing the EMR to address requests for reviewing medical images andas such, the PACS approved for the first facility may be provided viathe EMR on the user interface. It is further contemplated that, in yetother aspects, the EMR itself may have an EMR specific PACS that mayhave been requested by the first user and authorized for use at thefirst facility. Additionally, where the first facility is authorized forthe use of more than one PACS, the provider 218 will provide the firstuser, via the RDT application, a second authorized PACS for use. Assuch, the first user may be provider with two or more PACS for use. Inthis case, the first user will have the capability to choose which PACSthe user wants to use to view the medical images and has the ability totoggle back and forth between the first PACS and the second PACS to viewdifferent medical images. For example, if PACS A is the first PACSauthorized for use and PACS B is the second PACS authorized for use,then provider 218 may provide both PACS A and PACS B to the first userfor use. The first user can select which PACS is optimal for reviewingthe necessary medical images or the user may decide to utilize both PACSA and PACS B to view different types of medical images (e.g. CT scanversus mammogram). In that case, the first user may review certain typesof images on PACS A and others on PACS B. Additionally, the PACS willutilize the order number associated with the radiological exam andmedical image to be viewed to search for and provide the medical imagefor viewing on the RDT application 210.

After the first PACS and second PACS are provided to the first user bythe provider 218, the system 200 will generate, via generator 222, afirst medical image, via the first PACS, for review by the first user.The generator 222 will also generator a second medical image, via thesecond PACS provided by the provider 218 for use by the first user atthe first facility. Once the first medical image and the second medicalimages are reviewed by the first user, the first user will generateanalysis reports for each medical image. When the system 200 receiveseach analysis report, the system may store the report in the database204 or EMR 226. The results of each analysis report will be communicatedto the EMR 226 so that the appropriate treatment can be determined foreach individual associated with each medical image reviewed.

Additionally, in instances where the user or radiologist is workingremotely and may need to review medical images from another location,providing the first user with a first PACS and a second PACS authorizedfor the first user will allow the radiologist choice regarding whichPACS is optimal for the circumstance. For example, certain PACS may bemore user-friendly for use on a cell phone while other PACS may be moreuser friendly on a desktop via the RDT application.

It is also contemplated that in situations where a radiologist may beassociated with more than one facility on the shared domain, theprovider 218 may also provide the radiologist with multiple PACS for useso that the radiologist is able to review medical images from more thanone facility via the same RDT application. In other words, if theradiologist requesting the use of more than one PACS is working at twofacilities within a domain, the provider 218 can provide the radiologistwith different PACS, via the RDT application, for each facility.

In some aspects, the system 200 will receive requests from more than oneuser at either the same or a different facilities within the shareddomain. Unlike previous systems, the present system will allow thedifferent users at different facilities to use different PACS, therebynot limiting the PACS available for use in a single domain. In suchembodiments, the indication receiver 212 may receive a first indicationto launch a RDT application on a first user interface associated with afirst facility (e.g. the first user interface is located at the firstfacility or the first user is working remotely, but the first user'sdevice is associated with the first facility). The indication receiver212 will also receive a second indication to launch a RDT application ona second user interface at a second facility. Based on receiving theseindications, the request receiver 214 will receive a first request fromthe first user to utilize one or more PACS to view one or more medicalimages. The request receiver will also receive a second request from asecond user to utilize one or more PACS to view one or more images atthe second facility. Then, the accessor 216 will access the database toidentify one or more PACS authorized for use at each of the firstfacility and the second facility. Based on the identification of thePACS authorized for each facility, the provider 218 will provide thefirst user with one or more PACS authorized for use at the firstfacility. Additionally, the provider 218 will provide the second userwith one or more PACS authorized for use at the second facility.

In this example, once the first user is provided with one or more PACSauthorized for use at the first facility, the first user can make aselection as to which PACS the first user would like to utilize toreview the medical images. When this occurs, the selection receiver 220will receive a selection of a first PAC from the first user for viewingone or more medical images. The first user may be provided with a dropdown menu where the first user can select one or more PACS to use thatare provided by the provider 218 based on being authorized for the firstfacility. Similarly, the selection receiver 220 receives a selection ofa second PACS for viewing one or more medical images from the seconduser.

Once the first and second PACS selections are received by the selectionreceiver 220, the generator 222 will generate a first medical image, viathe first PACS, for review by the first user and a second medical image,via the second PACS, for review by the second user. Once the first userand second user view the first medical image and the second medicalimage, each user can analyze the medical image from the associatedradiological exam and provide the necessary assessment or diagnosis,which will be input into the EMR 226 for the use of other healthcareproviders in treating the individuals who underwent the radiologicalexam.

Turning next to FIG. 3, an exemplary system workflow of utilizingmultiple PACS to view one or more medical images is illustrated. Theprocess starts at block 302. As discussed herein, the present systemprovides for configuration of multiple PACS for a given domaincomprising one or more facilities at block 304. The PACS are configuredat the database level to allow for the use of multiple PACS by one userwithin a facility on a domain or multiple users at different facilitieswithin the same domain (e.g. multi-tenant domain). After multiple PACSare configured, the radiologist launches the RDT application 210 atblock 306. The RDT application 210 may be launched on any userinterface, including, but not limited to laptops, desktops, tablets,cellular devices, and the like.

At block 308, the system 200 will determine whether or not the workflowis PACS driven based on the PACS that is selected by the user. Prior tothis, the accessor 216 accesses the database to determine which PACS sare authorized for use at the specific facility by the user and theprovider 218 provides the authorized one or more PACSs to the user forselection (e.g. multiple PACSs are available for selection in a dropdown menu). When the selection receiver 220 receives the selection fromthe user for the PACS to be used, the PACS selected can either beunidirectional or bidirectional as shown in FIG. 5. If the PACS selectedis unidirectional, it means that the communication and requests can onlyoccur from the PACS to the RDT application 210. If the PACS selected isbidirectional, then the communication can be two ways—from the RDTapplication 210 to the PACS and from the PACS to the RDT application210.

If it is determined that the PACS selected is a unidirectional PACS(e.g. PACS B from FIG. 5), then the PACS is PACS driven (e.g.communication can only occur from the PACS to the RDT application 210).In this case, the radiologist will send the medical image associatedwith a radiological exam being viewed from the PACS selected to the RDTapplication 210 at block 310. Then, at block 312, the radiologist willopen the medical image in the RDT application and create the necessaryreport. Once the report is complete, the process ends at 324. Afterthis, the radiologist will move onto the next radiological exam andassociated medical image for viewing and reporting via the same or adifferent authorized PACS.

On the other hand, if the PACS selected by the user is determined not tobe PACS driven (e.g. the PACS is a bidirectional PACS such as PACS A inFIG. 5) at block 308, then the system 200 will determine whether thePACS selected is the PACS to be used at 314. If the PACS selected is notthe PACS to be used, then the radiologist will select the desired PACSand selected the radiological exam and associated medical image to beviewed and view it at 318. The PACS selected by the radiologist will beanother bidirectional PACS that is authorized for use at the facilityassociated with the radiologist. When this occurs, an order ID is sentfrom the PACS to the RDT application to search for the image to bereported. Then, the radiologist will view the medial image and create areport in the RDT application 210 at 322. Once completed, the processends at 324 and the radiologist can move onto the next radiological examand associated medical image to be reviewed. In the future, the selectedPACS can be saved as the default to be used for the next time. Forexample, if the radiologist selected PACS A 228 for use, then PACS A 228may be the default selection for the next medical image to be viewed.

By contrast, if the PACS selected is the PACS to be used at 314, thenthe radiologist will selected the specific radiological exam for whichan image is to be viewed at 316. A this time, the RDT application 210sends a request to the PACS along with an order ID for the exam so thatthe PACS can search for the specific exam within a PACS database. Oncelocated, the PACS will be launched and the medical image will bedisplayed at 320 in the image viewer 224 (e.g. the PACS viewer). Then,the radiologist will view the image and create a report in the RDTapplication 210 at 322. The report created by the radiologist stays inthe RDT application 210 while the requests to open the images stays withthe PACS. Once the image has been viewed and the report is completed,the process ends at 324.

Next, FIG. 4 illustrates the way PACS have been historically configuredat the registry level. An exemplary virtual desktop infrastructure (VDI)400 is shown. The VDI 400 is a hosting of desktop environments on acentral server and is a form of desktop virtualization. As discussed,PACS have been configured at the registry at the domain server, whichmeant that only one PACS could be configured for each domain. As shownin FIG. 4, the VDI 400 configuration interface comprises multiple fieldsof data. The first field, 402 indicates the name of the PACS that isconfigured to the system 200. In FIG. 4, the PACS configured is PACS A.Additionally, the VDI Mode 404 is shown as being bi-directional, meaningthat communication can occur from the RDT application 210 to theselected PACS and vice versa. In other aspects, the VDI mode may beuni-direction, meaning that the communication can only occur from thePACS to the RDT application 210. Further, the VDI 400 configurationinterface also includes an order ID 408, which is an identification codeassociated with the medical image or radiological exam to be reviewed.The pathway 410 location for the specific PACS is also shown. Thefacility 414 is shown as a drop down selection and lists the facilitieswithin the domain. As shown, all facilities are selected, meaning thatfacilities 1-8 are authorized to use PACS A. However, there is only onePACS, PACS A, that is authorized for use on this domain. As such, everyuser at each facility 1-8 within the domain may only utilize PACS A toview medical images.

By contrast, FIG. 5 illustrates the implementation of the presentdisclosure that allows for the use of multiple different PACSs bymultiple facilities within one domain. As shown, VDI 500 comprises thefollowing fields: name 502, VDI mode (bidirectional or unidirectional)504, VDI data 506, Order ID 508, the pathway location 510 and facility512. Unlike FIG. 4, where the PACS was configured at the registry level,in FIG. 5, each PACS authorized for each facility is stored separatelyas a key value within the database 204. This allows for differentfacilities within the same domain to use different PACS s and for usersat one facility to utilize more than one PACS for reviewing medicalimages or different users at different facilities within the same domainto utilize more than one PACS. As such, each facility has one or morePACS that are authorized for use. As shown in FIG. 5, there are threePACSs that have been added and available for use for this particulardomain, PACS A 516, PACS B 518, and PACS C 520. For PACS A 516, the VDImode 504 selected is bi-directional and the system 200 has approved allfacilities to use PACS A. As such, communication may occur from the RDTapplication 210 to the PACS A 516 and vice versa. Therefore, differentusers at each facility will be able to utilized PACS A to view imagesvia the RDT application 210.

Additionally, PACS B 518 has been selected to have a VDI mode 504 thatis unidirectional and is approved for use in facilities 1, 2, 3. PACS C520 has been selected to have a bidirectional VDI mode 504 and isapproved for use facilities 4, 5, and 6. Additionally, as seen in FIG.5, the option to add an EMR PACS 522 is also available. As such, thesystem 200 may be configured to not only use third party PACSs such asPACS A-C, but also the EMR PACS 236 offered via the EMR 226. The VDI 500demonstrates how multiple PACSs are available for use at differentfacilities within the same domain. Not all the facilities have receivedapprovals to use all the PACSs. However, the new VDI 500 shown in FIG. 5allows for greater flexibility for users. For example, a radiologist atfacility a can choose to use PACS A or B or both, depending on theradiologists preferences and medical image to be viewed. At the sametime, a radiologist associated with facility 4 can choose to use PACS Aor PACS C or both.

Next, FIG. 6 illustrates the implementation of VDI 500 in an exemplaryRDT application 600 on a radiologist's user interface. As shown, the RDTapplication 210 includes several informational fields such as the PACStype 602 (which includes a drop down menu to select the desired PACS),patient name 604, the procedure 606, the exam status 608, and the reportstatus 610. The radiologist has two patient names 604 whose medicalimages need to be reviewed. The first patient, Allen Smith 612'sprocedure 606 to be reviewed is a CT of the abdomen with contrast. Thesecond patient, Roger Bay 614's procedure 606 to be reviewed is an MRIof the pelvis. As seen on the RDT application, the radiologist canchoose which PACS type 602 to utilize to view each of medical images.PACSs A-D and EMR PACS are authorized and available to use. As such, theradiologist may select the same PACS (e.g. PACS A) or two differentPACSs (e.g. PACS A and EMR PACS) to review the two different medicalimages for Allen Smith and Roger Day.

FIG. 7 further illustrates an exemplary system 700 in which multiplePACSs are available and authorized for users at multiple facilities. Asshown, database 204 has four PACSs configured to it. Each PACS isconfigured to capture, store, and display one or more medical images onuser interfaces. Each of PACS A 706, PACS B 708, PACS C 710, and PACS D712 have been identified by the accessor 216 as authorized for use atthe first facility 724 and the second facility 726. In this example, afirst radiologist 716 is working from a first facility 724 and utilizinga first RDT application 706. A second radiologist 722 is working from asecond facility 726 and utilizing a second RDT application 710. In thisexample, the indication receiver 212 has received an indication from thefirst radiologist 716 to launch the first RDT application 706 on thefirst user's interface 718 and the request receiver 214 has received afirst request from the first radiologist 716 to utilize one or morePACSs to view one or more medical images. Based on such a request, theaccessor 216 accessed the database 204 to identify one or more PACS thatare authorized for use at the first facility 724. The provider 218 thenprovides the first radiologist 716 with one or more PACS authorized foruse by the first radiologist 716 at the first facility 724. As shown,the first radiologist 716 has selected PACS A to be used on the firstuser interface 718 and the selection receiver 220 will receive theselection. Also, as shown with the two directional arrow, PACS A 228 isa bi-directional PACS. Based on this, the generator 222 will generate, afirst medical image 730, via PACS A 228, for review by the firstradiologist 716. In this instance, the first medical image 730 to bereviewed by the first radiologist 716 is an x-ray of a bone. Uponreceiving the first medical image 730, the first radiologist 716 willreview the second medical image 730 and make the appropriateassessment/diagnosis and then generate a report accordingly. The reportgenerated will be either directly input into the EMR 226 or communicatedto the EMR 226 for use in treatment of the individual who underwent thex-ray.

The same process will take place for the second radiologist 722 at thesecond facility 726. After the second radiologist 722 selectsbidirectional PACS B 230 from the authorized PACSs provided by theprovider 218 for the second facility 726 and the selection receiver 220receives the selection of PACS B 230, the generator 222 will generate asecond medical image 732, via PACS B 230, for review by the secondradiologist 722. In this case, the second medical image 732 is a CT scanof the brain. As shown, by configuring the PACSs to be stored at thedatabase 204 instead of at a registry within the system 200, both thefirst radiologist 716 and the second radiologist 722, who share onedomain, are able to utilize different PACSs for review and analysis ofmedical images.

FIG. 8 illustrates a flow diagram showing an exemplary method 800 ofexecuting embodiments of the present invention. Beginning with block802, an indication is received by the indication receiver 212 to launcha radiology desktop application on a user interface at a first facility.At block 804, the request receiver 214 receivers the request from thefirst user to utilize one or more PACSs to view one or more medicalimages. As discussed, the first user may request to view the one or moremedical images via the RDT application 210 on a user desktop or via theEMR 226. After receiving the request, the accessor 216 accesses thedatabase 204 to identify one or more PACS authorized for use at thefirst facility at block 806. In aspects, all facilities may beauthorized to use all configured PACSs while in other instances, certainfacilities may be authorized to use certain PACSs while others are not.Then, at block 808, the provider 218, provides, via the first userinterface of the RDT application, a first PACS authorized for use by thefirst user at the first facility at block 810. At block 810, theprovider 218 will provide the first user, via the first user interfaceof the RDT application 210, with a second PACS authorized for use by thefirst user at the first facility.

FIG. 9. illustrates a flow diagram depicting another exemplary method900 of executing embodiments of the present invention. In the method 900illustrated in FIG. 9, two different users at two different facilitiesare utilizing the same domain. As such, the two users may request thesame or different PACS to view medical images and each facility may beauthorized to use the same or different PACS. Beginning with block 902,the indication receiver 212 receives a first indication to launch aradiology desktop application on a first user interface at a firstfacility. Then, the indication receiver 212 receives a second indicationto launch an RDT application on a second user interface at a secondfacility at block 904. In this aspect, the first user and second usersare located at a first and second facility. It is contemplated that thefirst facility and the second facility may be facilities within the samehealthcare system. For example, the first facility might be an urgentcare/emergency department facility and the second facility might be ahospital. The first facility and second facility may or may not bephysically attached or adjacent to one another. Additionally, it iscontemplated that in other aspects, the first facility and the secondfacility may not have any connection to one another. For example, inrural areas, the first facility may be a first community hospitallocated in a first small town and the second facility may be a secondcommunity hospital located in a second small town several hundreds ofmiles away. The two facilities may share the same domain in order to becost efficient. However, each facility may have different needs andcapabilities with regard to radiological examinations and as such, eachfacility may want to utilize different PACS s for viewing medicalimages.

Once the first indication and the second indications to launch RDTapplication 210 on each user's interface are received, the requestreceiver 214 receives a first request from the first user to utilize oneor more PACS to view one or more medical images at block 906. Then, atblock 908, the request receiver 214 receives a second request from thesecond user to utilize one or more PACSs to view one or more medicalimages. Each user may request to utilize one or more PACSs based on userpreference or based on the type of medical image to be viewed.

Next, the accessor 216 accesses the database to identify one or morePACSs authorized for use at each of the first facility and the secondfacility at block 910. As previously mentioned, each facility located onthe same domain may not be authorized to utilize each PACS available. Assuch, even if a user requests to use a PACS, the system 200, will needto determine whether the specific PACS requested is authorized for thefacility. Since different facilities may be authorize to use differentPACS s, the accessor 216 will identify different PACS authorized foreach facility.

Once the accessor 216 has accessed the database 204 and identified thePACS authorized for use at the first facility and the second facility,the provider 218 will provide the first user with one or more PACSsauthorized for use by the first facility at block 912. The provider 218will also provide the second user with the one or more PACS authorizedfor use at the second facility at block 914. After providing theauthorized PACS to the first user and the second user, the selectionreceiver 220 receives a selection from the first user of a first PACSfor viewing one or more medical images at block 916. The selectionreceiver 220 also receives a s selection from the second user of asecond PACS for user by the user at the second facility at block 918.

Then, based on the first PACS selected by the first user, the generator222 will generate a first medical image, for review by the first user atthe first facility at block 920. At block 922, the generator 222 willgenerate a second medical image for review by the second user based onthe second PACS selected by the second user. The first and second usersmay then review each medical image and provide the appropriate reportingvia the RDT Application 210. The report generated by the first andsecond users may be stored in the database 204 or communicated to theEMR 226.

While block 902-922 present the method in order discussed above, it iscontemplated that the system 200 may receive the indications andrequests from the first user at the first facility and the second userat the second facility simultaneously. As such, the system 200 mayprovide the both the first user and the second users with the PACSsauthorized for each facility at the same time and then, in response, tothe selections made by each user, generator the medical images forreview by each user simultaneously. System 200 is adaptable andintelligent and as such, the presented method is exemplary andvariations in the order are contemplated herein.

The present invention has been described in relation to particularembodiments, which are intended in all respects to be illustrativerather than restrictive. Further, the present invention is not limitedto these embodiments, but variations and modifications may be madewithout departing from the scope of the present invention.

What is claimed is:
 1. A dynamic system useful in a computer healthcaresystem that allows a healthcare provider to utilize multiple PictureArchiving Communication Systems (PACS) to view one or more medicalimages, the system comprising one or more processors configured to:receive an indication to launch a radiology desktop (RDT) application ona first user interface at a first facility; receive a request from afirst user to utilize one or more PACS to view one or more medicalimages; access a database to identify the one or more PACS authorizedfor use at the first facility; provide the first user, via the firstuser's interface of the RDT application, with a first PACS authorizedfor use by the first user at the first facility; and provide the firstuser, via the first user's interface of the RDT application, with asecond PACS authorized for use by the first user at the first facility.2. The system of claim 1, wherein the system further generates a firstmedical image, via the first PACS, for review by the first user.
 3. Thesystem of claim 2, wherein the system receives an analysis report fromthe first user for the first medical image viewed via the first PACS. 4.The system of claim 3, wherein the system further stores the analysisreport from the first user regarding the first medical image in thedatabase.
 5. The system of claim 1, wherein the system further generatesa second medical image, via the second PACS, for review by the firstuser.
 6. The system of claim 5, wherein the receives an analysis reportfrom the first user for the second medical image viewed via the firstPACS.
 7. The system of claim 6, wherein the system further stores theanalysis report from the first user regarding the second medical imagein the database.
 8. The system of claim 1, wherein receiving the requestfrom the first user to utilize the one or more PACS to view the one ormore medical images further includes receiving an order numberassociated with the one or more medical images.
 9. The system of claim1, wherein the one or more PACS authorized for use at the first facilityare unidirectional.
 10. The system of claim 1, wherein the one or morePACS authorized for use are at the first facility are bidirectional. 11.A dynamic system useful in a computer healthcare system that allows ahealthcare provider to utilize multiple Picture Archiving CommunicationSystems (PACS) to view one or more medical images, the systemcomprising: a database comprising one or more PACS configured tocapture, store, and display one or more medical images on one or moreuser interfaces associated with one or more facilities; one or moreprocessors; and a storage device storing a computer program productcomprising computer instructions that, upon execution by the one or moreprocessors, cause the one or more processors to perform operationscomprising: receiving a first indication to launch a radiology desktop(RDT) application on a first user interface at a first facility;receiving a second indication to launch a RDT application on a seconduser interface at a second facility; receiving a first request from afirst user to utilize one or more PACS to view one or more medicalimages; receiving a second request from a second user to utilize one ormore PACS to view one or more medical images; accessing the database toidentify one or more PACS authorized for use at each of the firstfacility and the second facility; providing the first user with one ormore PACS authorized for use by the first user at the first facility;providing the second user with one or more PACS authorized for use bythe second user at the second facility; receiving a selection from thefirst user of a first PACS for viewing the one or more medical images;receiving a selection from the second user of a second PACS for viewingthe one or more medical images; based on the first PACS selected by thefirst user, generating a first medical image, via the first PACS, forreview by the first user, and based on the second PACS selected by thesecond user, generating a second medical image, via the second PACS, forreview by the second user.
 12. The system of claim 11, wherein theselection of the first PACS by the first user is saved as a default PACSselection for future use.
 13. The system of claim 11, wherein theselection of the second PACS by the second user is saved as a defaultPACS selection for future use.
 14. The system of claim 11, wherein thefirst PACS and the second PACS are the same type of PACS.
 15. The systemof claim 11, wherein the first PACS and the second PACS are differenttypes of PACS.
 16. The system of claim 11, wherein the first facilityand the second facility are part of a multi-tenant domain.
 17. Thesystem of claim 11, wherein the first user generates a first report forthe first medical image and the second user generates a second reportfor the second medical image.
 18. The system of claim 17, wherein thefirst report and second report generated are transmitted to anelectronic medical record.
 19. A method carried out by a server toutilize multiple Picture Archiving Communication Systems (PACS) to viewradiology images, the method comprising: receiving an indication tolaunch a radiology desktop (RDT) application on a first user interfaceat a first facility; receiving a request from a first user to utilizeone or more PACS to view one or more medical images; accessing adatabase to identify one or more PACS authorized for use at the firstfacility; providing the first user, via the first user's interface ofthe RDT application, with a first PACS authorized for use by the firstuser at the first facility; and providing the first user, via the firstuser's interface of the RDT application, with a second PACS authorizedfor use by the first user at the first facility.
 20. The method of claim19, further comprising generating a generating a first medical image,via the first PACS, and a second medical image, via the second PACS, forreview by the first user.